Provider Demographics
NPI:1316628787
Name:SMITH, TIMOTHY ROBERTS
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROBERTS
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 KY 225
Mailing Address - Street 2:PO BOX 324
Mailing Address - City:ARTEMUS
Mailing Address - State:KY
Mailing Address - Zip Code:40903
Mailing Address - Country:US
Mailing Address - Phone:606-622-3850
Mailing Address - Fax:
Practice Address - Street 1:103 S PINE ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1610
Practice Address - Country:US
Practice Address - Phone:606-254-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist